Development of a Prediction Model for Surgery or Early Mortality at the Time of Initial Assessment for Necrotizing Enterocolitis

Sujir P Nayak; Mariela Sánchez-Rosado; Jordan D Reis; L Steven Brown; Kate L Mangona; Priya Sharma; David B Nelson; Myra H Wyckoff; Samir Pandya; Imran N Mir; Luc P Brion

doi:10.1055/a-2253-8656

Development of a Prediction Model for Surgery or Early Mortality at the Time of Initial Assessment for Necrotizing Enterocolitis

Am J Perinatol. 2024 Feb 20. doi: 10.1055/a-2253-8656. Online ahead of print.

Authors

Sujir P Nayak¹, Mariela Sánchez-Rosado^{1

2}, Jordan D Reis^{1

3}, L Steven Brown⁴, Kate L Mangona⁵, Priya Sharma^{1

3}, David B Nelson⁶, Myra H Wyckoff¹, Samir Pandya⁷, Imran N Mir¹, Luc P Brion¹

Affiliations

¹ Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas.
² Division of Neonatology, Joe DiMaggio Children's Hospital, Hollywood, Florida.
³ Department of Pediatrics, Baylor Scott and White, Dallas, Texas.
⁴ Department of Research, Parkland Health and Hospital System, Dallas, Texas.
⁵ Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas.
⁶ Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, and Parkland Health, Dallas, Texas.
⁷ Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.

PMID: 38272063
DOI: 10.1055/a-2253-8656

Abstract

Objective: No available scale, at the time of initial evaluation for necrotizing enterocolitis (NEC), accurately predicts, that is, with an area under the curve (AUC) ≥0.9, which preterm infants will undergo surgery for NEC stage III or die within a week.

Study design: This is a retrospective cohort study (n = 261) of preterm infants with <33 weeks' gestation or <1,500 g birthweight with either suspected or with definite NEC born at Parkland Hospital between 2009 and 2021. A prediction model using the new HASOFA SCORE (H: yperglycemia, H: yperkalemia, use of inotropes for H: ypotension during the prior week, A: cidemia, Neonatal S: equential O: rgan F: ailure A: ssessment [nSOFA: ] score) was compared with a similar model using the nSOFA score.

Results: Among 261 infants, 112 infants had NEC stage I, 68 with NEC stage II, and 81 with NEC stage III based on modified Bell's classification. The primary outcome, surgery for NEC stage III or death within a week, occurred in 81 infants (surgery in 66 infants and death in 38 infants). All infants with pneumoperitoneum or abdominal compartment syndrome either died or had surgery. The HASOFA and the nSOFA scores were evaluated in 254 and 253 infants, respectively, at the time of the initial workup for NEC. Both models were internally validated. The HASOFA model was a better predictor of surgery for NEC stage III or death within a week than the nSOFA model, with greater AUC 0.909 versus 0.825, respectively, p < 0.001. Combining HASOFA at initial assessment with concurrent or later presence of abdominal wall erythema or portal gas improved the prediction surgery for NEC stage III or death with AUC 0.942 or 0.956, respectively.

Conclusion: Using this new internally validated prediction model, surgery for NEC stage III or death within a week can be accurately predicted at the time of initial assessment for NEC.

Key points: · No available scale, at initial evaluation, accurately predicts which preterm infants will undergo surgery for NEC stage III or die within a week.. · In this retrospective cohort study of 261 preterm infants with either suspected or definite NEC we developed a new prediction model (HASOFA score).. · The HASOFA-model had high discrimination (AUC 0.909) and excellent calibration and was internally validated..